Self Injury Sexuality Spirituality by MikeJenny


									Self Injury, Sexuality & Spirituality:
          Putting the Pieces Together

                                Joyce Wagner
                     Purpose of Study
   To explore possible relationships between college-aged
    1.    Self-injurious behaviors (SIB),
    2.    Sexuality maturity, and
    3.    Spiritual development

   Using the following frameworks:
         Erikson‟s Psycho-Social Model1
         Perry‟s and Chickering‟s Intellectual Developmental Models2,3
         Fowler‟s Faith Developmental Model4
         Anderson & Cyranowski research on female sexual schemas5

         Presently there is, “much disagreement among therapists as to whether
         treatment for self injury should focus on the here and now… or on trying
         to recall and resolve the traumas of the past” 6
        Current Facts – Self Injury
   Exponential growth since 1980‟s
   15% of the US population (2-8 million individuals)
    engage in behaviors7
   Currently considered one of the largest adolescent
    problems in US/UK8
       Average age of onset 14
   College-aged considered to be highest risk group: 17% of
    undergraduate students self-report a history of behavior
       20% women and 14% men9
   Slightly more women (55%) than men (45%)10

          “Patients who engage in self-destructive behavior… are currently
          one of the most difficult-to-treat groups in both inpatient and
          outpatient settings”11
                Self Injury Defined
   “The deliberate, direct destruction or alteration of body tissue
    without conscious suicidal intent, but resulting in injury severe
    enough for tissue damage to occur”12
   Types (in order of frequency)
       Scratching or Pinching
       Banging or Punching objects (#1 in Males)
       Cutting (#1 in Females)
       Banging or Punching self (e.g. head)
       Carving words into skin
       Ripping or tearing skin
       Burning self
       Rubbing sharp objects into skin
       Trichotillomania
       Breaking bones
       Ingesting Substances/Objects
       Dropping acid onto skin13
        Reasons behind Self Injury
   Primary clinical Reasons:
       An invalidating environment (e.g. lack of sufficient parental
       Childhood Sexual Abuse ( ~ 54%)15
       Child Abuse or Neglect ( ~ 50-70%)
       Questioning of Sexual Identity16
   Socio-Cultural Reasons:
       fewer coping skills,
       contagion theory,
       more awareness and discussion,
       increased social stressors,
       media influence (e.g. music, movies, Internet etc.),
       family stress, dysfunction, relationship and/or abuse,
       greater social acceptance (e.g. tattoos, piercing etc.),
       increased isolation, and
       increased anxiety17
„Famous‟ Self-injurers
   Princess Diana      Courtney Love
   Johnny Depp         Van Gogh
   Colin Farrell       Marilyn Manson
                        Drew Barrymore
   Fiona Apple         Christina Ricci
   Angelina Jolie
Framework #1: Erikson‟s Psychosocial
Developmental Model
   Eight stages of ego identity development:
       Five typically experienced during first 20 years of life
   At each stage developmental task confronts the
    individual, resulting in a crisis.
       Mastery allows for further personality development to precede
       Unsuccessful resolution, leads toward negative view of self,
        making resolution of each successive crisis more difficult. (e.g.
        personality disorder symptoms)18
   College-Age (Stage 5) Identity vs. Identity Confusion.
       Four issues addressed: (1) achievement, (2) moratorium, (3)
        foreclosure, and (4) diffusion - each lead to an individual who is
        more separate from their parents19
       Successful completion includes: (1) differentiation, (2)
        functional autonomy, (3) behavioral boundaries, and (4)
        financial independence20
Framework #2: Perry‟s Model of
Intellectual and Moral Development
    Four Stages (Nine Positions) of Student Development:
    1.   All problems can be solved if „right‟ answer is found. New
         awareness that authorities may disagree with personal views
    2.   Problems have multiple and sometimes conflicting answers.
         Students begin sorting issues into: (1) problems with known
         solutions and, (2) problems still unsolved/unsolvable.
    3.   Incorporation of previously objective material results in
         relativistic, subjective thinking. Concurrent feelings of
         uneasiness/confusion as tolerance of others grows while
         students search for their place in the larger culture. Students
         deal with tension by making choices and committing to
         solutions that fit within their personal schema – although
         experiencing great doubt.
    4.   Integrating knowledge learned from others with that from
         personal experience occurs. Students also make firm
         commitments and experience the implications of these choices.21
Framework #2: Chickering‟s 7
Vectors of College Student Dev.
           Seven Vectors of Student Development:
           1.   Increased competence intellectually, physically
                (e.g. athletics, artistic abilities) and
                interpersonally. Students begin trusting their
                abilities/integrating skills into stable self.
           2.   Powerful emotions contained by (1) learning
                appropriate channels for releasing irritations
                before they explode, (2) dealing with fears
                before they immobilize, and (3) healing
                emotional wounds before they infect other
           3.   Issues of self-sufficiency and responsibility
                increase, moving student towards relative
                autonomy (e.g. personal values/beliefs).
           4.   Development of mature interpersonal
                relationships. Also (1) increased
                tolerance/appreciation of differences, and (2)
                capacity for intimacy occurs.
Chickering’s Model Continued
 5.   Students identity more firmly established through successful:
      (1) assembly of pieces of prior stages into meaningful pattern,
      (2) exploration of boundaries (safe versus destructive
      behaviors), and (3) becoming comfortable with self (e.g. body,
      gender/sexual orientation, sense of self, clarification of roles/life-
      style, self-esteem and personal stability)
 6.   Increasing development of life purpose including: (1) finding
      direction in life, (2) establishing philosophy of life, and (3)
      beginning to ask broader and more existential questions about
      meaning and purpose
 7.   Development of personal integrity by affirmation of beliefs and
      core values while still respecting
      those of others. Shift from absolute
      stance to more relativism. Determination
      of which aspects of upbringing to
      keep/give up. Ultimate goal is to arrive at
      a place of congruence – where
      personal beliefs and values align.22
Framework #4: Fowler‟s Faith
Development Model
    Six Stages of Faith Development
    1.   Intuitive-Projective Faith (ages 2-7) - Individuals construct their
         understanding of faith in magical and fantasy filled ways.
    2.   Mythic-Literal Faith (ages 7-11) - Individuals begin concrete
         operational (e.g. logical, linear, orderly) thought.
    3.   Synthetic-Conventional Faith (Early Adolescence*) -
         Individuals begin formal operational thought; start to pull
         together threads of faith from the past and projecting these
         beliefs onto the future. Faith expression is convention and based
         on conforming to the majority.
    4.   Individuative-Reflective Faith (Young Adulthood*) -
         Individuals constructing a faith that is uniquely their own,
         moving from a place of honoring expectations to one of
         authenticity. Faith expression involves questioning (angst) and
         critical reflection on personal faith.
         Fowler’s Model Continued
    5.    Conjunctive Faith (Middle Adulthood*) - Individuals realize
          the paradoxes of faith and begin to live comfortably with faith/
          questions. Faith expression includes a re-discovery of the
          richness of symbol and mastery.
    6.    Universalizing Faith (Not before Middle Adulthood*) -
          Individuals at this stage are rare and characterized by the giving
          up of self for the sake of the community. They are at harmony
          with one, God and neighbor and concerned with global issues.23

   College students typically begin at stage three and move
    to stage four.24
   Spiritual maturity is characterized by: (1) increasing
    complexity, (2) differentiation, (3) autonomy, (4)
    humility, and (5) activism.25
          * While faith is universal, faith development may be stunted or halted at
          any stage; some adults remain at stage three throughout life,
          progression through latter stages is particularly contextual
Religion & Spirituality Defined
   Religion, as the term has come to be used, generally
    refers to externalized behaviors such as, (1) organized
    activities, (2) attendance at services, (3) performance of
    rituals, (4) church membership, (5) commitment to
    organizational beliefs, and (6) adherence to
    institutionally based belief systems.26
       “A system of beliefs in a divine or superhuman power, and
        practices of worship or other rituals directed towards such a
   Spirituality is broadly characterized as (1) feelings or
    experiences of connectedness, (2) relationship with
    sacred beings or forces, (3) interconnectedness, (4)
    individualized values, (5) beliefs and practices issues,
    and (6) the core function of religion.28
       “The way one lives out one‟s faith in daily life, the way a person
        relates to the ultimate conditions of existence”29
Framework #5: Anderson &
Cyranowski‟s Sexual Self-Schema
   Sexual self-schema: "cognitive generalizations about
    sexual aspects of oneself that are derived from past
    experience, manifest in current experience, influential in
    the processing of sexually relevant social information,
    and guide sexual behavior”30
       Positive schema women: (1) are more able to enter sexual
        relationships more willingly, (2) possess a wider variety of
        sexual repertoire, and (3) display more positive emotions within
        a sexual relationship.
       Negative schema women: (1) are less sexual experienced, (2)
        have fewer positive emotions regarding sexual relationships, and
        (3) exhibit less skill and comfort (e.g. shame, guilt) within the
        context of an intimate relationship. 31
Anderson & Cyranowski Cont.
       Aschematic schema women hold neither strong positive or
        negative views personal sexuality.
       Coschematic schema women have both strong positive and
        negative feelings regarding personal sexuality. They exhibit a (1)
        greater ability to fall in love, and (2) more relationship
        satisfaction than their aschematic counterparts.32
       Aschematic and Coschematic Women Display more (1) sexual
        avoidance, (2) sexual preoccupation, and (3) sexual anxiety
        along with less (4) sexual desirability, and (5) sexual arousal
        ability than their positively schema‟ed counterparts.

   Sexual Schemas and Attachment Theory
       Aschematic and Coschematic women display higher levels of
        anxious attachment styles than either negative or positive
       Negative schema‟ed women exhibit a more avoidant attachment
        style than the other three groups.33
         Questions Posed by Project
1.   What is the relationship between self-injurious
     behaviors and spiritual development among college-aged
2.   What is the relationship between self-injurious
     behaviors and sexuality maturity among college-aged
3.   Is their a relationship between self-injurious behaviors
     and socio-demographic variables?
      SIB & Spirituality Research

     Not currently researched but warranted due to:
        Positive affects of spiritual support on physical/psychological
         health, coping and social support on individuals in general34
        SIB & Sexuality Research
   Anxious or avoidant attachment styles are linked to SIB
   Negative attachment is also related to lower levels of
    affective regulation, which in turn is related to SIB 36
       “empirical literature suggests that both disruptions in
        attachment and the perceived quality of attachment to
        caregivers may play an important role in the etiology of self-
        harm” 37
   Data on female sexuality demonstrates possible
    correlations between negative sexual schemas and poor
    attachment patterns 38
       “early attachment experience may set the stage for the
        development of particular sexual self-views” 39
   Preliminary studies suggest that SIB in women may be
    related to feelings about their identity and sexuality,
    especially in regard to unexpressed, unaccepted or
    invalidated feelings. 40
            Quantitative Measures
    Participants will also be asked to complete the
    1.   The Deliberate Self Harm Inventory (DSHI) - A questionnaire
         consisting of seventeen behaviorally based items that assess an
         individual‟s history of self injury,41
    2.   The Faith Development Scale (FDS) - An eight items inventory
         designed to yield an overall index of an individual‟s current faith
         development at either stage 2-3 or 4-5, 42
    3.   The Sexual Self Schema Scale (Women’s Form) (SSSS) - A „discrete
         and unobtrusive‟, index of personality trait markers which
         provides a semantic representation of a "sexual woman" 43

    In addition, Socio-demographic information will be
     gathered in the following categories(1) racial/ethnic
     identity, (2) year in school, (3) current income levels, (4)
     sexual orientation, (5) current and past spirituality, (6)
     marital status, and (7) regional locale
             Qualitative Questions
    Participants in this study will be asked to answer the
     following open-ended questions:
    1.   How do you think your religion/spirituality affects your
         sexuality, both today and in the past and vice versa?
    2.   How do you think your religion/spirituality affects your self-
         injurious behaviors, both today and in the past and vice versa?
    3.   How do you think your sexuality affects your self-injurious
         behaviors, both today and in the past, and vice versa?

           “Cutting is one of the
           hardest things to quit and
           the easiest to go back to” –
Procedural Methods for Project
1.   Approval of participant resources (i.e., instructions,
     informed consent form and statement of consent) along
     with data collection instruments by Regent University‟s
     Human Subjects Review Committee.
2.   Convert all measures to web-based format (e.g.
3.   Recruit ~200 participants through e-mail to ~350 College
     and University Counseling Center Directors nationwide
     using American College Counseling Association Listserv
     (ACCA-L) or Counseling Center Director (CCD)
        E-mail will highlight (1) general details of research project, (2)
         goals of the study along with (3) risks and benefits for
Procedural Methods Continued
4.       Interested directors asked to reply to primary
         investigator and then supplied with more specific
         information (e.g. participant materials,
         instrumentation) required to complete project.
5.       Participants agree to supply participants for research
         using past and present clients (ages 18-25) who had
         sought services for issues relating to self-injury.
           Directors will be instructed that for each completed survey
            they will receive a $5.00 credit at; clients
            also received a $5.00 electronically redeemable credit to
6.       Quantitative data statistically analyzed (e.g.
         logistical/multiple regression). Qualitative content
         examined for themes related to self injury, sexuality and
         spirituality using a phenomological approach.
                                    Cited Resources
1.    Erikson, 1950, 1959, 1963, 1964, 1968
2.    Perry, 1970, 1981
3.    Chickering, 1969, 1993
4.    Fowler, 1981, 1996
5.    Anderson & Cyranowski, 1994, 1998
6.    Strong, 1998 (p. 174).
7.    Ross & Health, 2002; Deiter, Nicholls, & Pearlman, 2000; Whitlock & Purington, 2004
8.    Belgamwar, Hodgson, & Waters, 2006; Best, 2005; Derouin, & Bravender, Olfson, Gameroff &
      Marcus, 2005b; O‟Loughlin & Sherwood, 2005; Whitlock et al., 2006
9.    Favazza, DeRosear & Conterio, 1998; White, Trepal-Wollenzier & Nolan, 2002; Whitlock,
      Eckenrode & Silverman, 2006
10.   Briere & Gil, 1998; Deiter, Nicholls & Pearlman, 2000; Dulit, Fyer, Leon, Brodsky & Frances, 1994;
      Gratz, 2001; Lundh, Karim, & Quilisch, 2007; Martin, Rozanes, Pearce & Allison, 1995
11.   Fowler, Hilsenroth & Nolan, 2000 (p. 365)
12.   Gratz, 2006 (p. 241)
13.   Whitlock, Eckenrode & Silverman, 2006
14.   Linehan, 1993; Saxe, Chawla & van der Kolk, 2002; Yates, 2004
15.   Crouch, 2004; Denov, 2004; Hawton, Hall & Simkin, 2003; Kumar, Pepe & Steer, 2004; Nicholson,
      2004; Nixon, Cloutier & Aggarwal, 2002; Olfson, Gameroff & Marcus, 2005a; Ross & Heath,
      2002; Strong, 1998
16.   Alexander & Clare, 2004; McKay, et al., 2004; Skegg & Nada-Raja, 2003; Whitlock, et al., 2006a
                    Cited Resources Continued
17.   Rosen & Walsh, 1989; Whitlock, et al., 2006b; Yates, 2004
18.   Johnson, 1993
19.   Constantinople, 1969
20.   Erikson, 1968
21.   Perry, 1970, 1981
22.   Chickering, 1969; Chickering & Reisser, 1993
23.   Fowler, 1981, 1996
24.   Chae, Kelly, Brown & Bolden, 2004; Cook & Hillman, 2006, Das & Harries, 1996; Leak, 2003; Lee
      2002; Love, 2002
25.   Leak, Loucks & Bowlin, 1999
26.   Peteet, 1994
27.   Argyle & Beit-Hallahmi, 1975
28.   Zinnbauer & Pargament, 2005
29.   Hart, 1994 (p. 23)
30.   Anderson & Cyranowski, 1994 (p. 1079)
31.   Ibid.
32.   Cyranowski & Anderson, 1999
33.   Ibid.
34.   Cohen, Underwood & Gottlieb, 2000; Levin, 1996; Lindgren and Coursey, 1995; Koenig,
      McCullough & Larson, 2001; Pargament, 1997; Ryff & Singer, 1995; Smith, McCullough & Poll,
      2003; Strawbridge, Shema, Cohen & Kaplan, 2001
                     Cited Resources Continued
35.   Batson, Schoenrad & Ventis, 1993, Cochran, 1992; Regnerus, Smith & Fritsch 2003; Smith & Faris,
      2003; Wallace & Forman, 1998; Wallace & Williams, 1997
36.   Gratz et al., 2002; Gratz, 2006; Klayman Faber, 2002; Levy, 2005; van der Kolk, 1996; van der Kolk,
      Perry & Herman, 1991; Wright, Briggs & Behringer, 2005
37.   Bowlby, 1969; Crittenden, 1997; Kogan & Carter, 1996; Conterio & Lader, 1998; Linehan, 1993; van
      der Kolk, 1996
38.   Cyranowski & Anderson, 1998
39.   Ibid. (p. 1376)
40.   Alexander & Clare, 2004: McKay et al., 2004; Skegg & Nada-Raja, 2003; Whitlock et al, 2006
41.   Gratz, 2001
42.   Leak, Loucks & Bowlin, 1999
43.   Anderson & Cyranowski, 1994

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